A little hair on the head, back, and tail using the hair brush. Also create some hair roots to help it blend. Create the elephant reflection via duplicate/vertical flip and use the smudge tools to create waves on the reflection.
Add bubbles using the bubble tool, as well as the bubble reflection, use smudge tool on the reflection to create waves. Color the straw on the elephants back.
Using the black string from the source, invert the color to white and duplicate. Add some color to the balloon inflation valve and warp to vary the shapes. Add additional balloon shadows.